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Organ donors should get free funeral

What would you like in return for your organs? As demand for organs continues to outstrip supply, ethical ways of rewarding people for donating need to be brought in, says a new report from the Nuffield Council on Bioethics, based in London.

Top of the list is the idea of paying for the funerals of people who agree that their organs can be transplanted after they die.

Almost 8000 people are waiting for a transplant in the UK. Although 18 million people are signed up to the British organ donor register, three people every day die waiting for a donor.

The council hopes that offering to pay funeral expenses would encourage more people to sign up. If introduced, it would be the first such scheme in the world. Keith Rigg, a consultant transplant surgeon and co-author of the report, says a pilot study should be introduced.

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The average British funeral costs nearly £7000, but a funeral-for-transplant scheme would quickly pay for itself. Kidney transplants alone save the taxpayer around £13000 a year per patient, as they remove the need for costly dialysis. Rigg says that reduced treatment after organ transplantation saved the British National Health Service more than £50 million in 2008.

Opt in or opt out?

In the UK, the donor must have explicitly given consent before their organs can be taken, but in some other countries, such as Spain, consent is assumed unless a person has registered their refusal. There have long been calls for such an opt-out system to be introduced in the UK as a way to increase donor numbers.

Opt-out systems might seem a sure-fire way of getting more organs, but the report suggests that they are not. “There is uncertainty about whether or not an opt-out system could lead to more organs being donated,” says Rigg. Although Spain has the highest rate of organ donation in the world, Sweden, which also practises opt-out, has a rate lower than the UK.

There will always be uncertainty about what the person really wanted with an opt-out system, says Bobbie Farsides, a medical ethicist at Brighton and Sussex Medical School, UK. The absence of a request to opt out could be a sign of the donor being confused or misinformed about the process, rather than a willingness to donate.

Living free

The report also made recommendations about live organ donation. To prevent donors being exploited or harmed by repeat donations, it is against European law to offer payments directly for organs – and the authors say altruistic donation should remain the rule. Any additional money given over expenses could undermine the motive of helping others, they say.

For egg and sperm donations, however, they recommend that a cap of £250 for expenses should be increased to match the lost earnings of anyone willing to donate. With half of all fertility clinics in the UK short of sperm, and nearly all clinics short of eggs, no financial barrier should prevent donation, says Farsides.

Price of eggs

Women who are willing to suffer the discomforts and possible health effects of donating eggs for medical research should be paid over and above the expenses given to those donating for fertility treatment, however, the report concluded.

Participants in phase I clinical trials often receive hundreds of pounds for their involvement, says Marilyn Strathern, an anthropologist who also worked on the report.

“Donating eggs for research purposes is different from donating to help someone else’s treatment. You’re not trying to help a particular individual – you are more a participant in a research exercise,” she says. A registry should be set up to ensure donations are monitored and regulated, she adds.